In brief

An MRI report saying "herniation" or "bulge" does not by itself explain your pain: many people with no back pain have the same findings. A doctor diagnoses and decides the approach. A physical therapist helps you move and return to everyday activity — no "putting the disc back", no promises. Numbness around the genitals or back passage, or new problems passing urine: call 103 immediately.

This article does not replace a doctor's consultation. A physical therapist does not diagnose, does not interpret scans and does not prescribe treatment. Questions of surgery, medication and how much load is safe are for your doctor to decide.

Herniation, bulge, "osteochondrosis": what the words in an MRI report mean

Most people read their MRI report before a doctor has seen it — and unfamiliar words are more frightening than they need to be. What they mean in your particular case is for the doctor who has looked at the images and examined you to say.

An intervertebral disc is a springy cushion between two vertebrae: a tough fibrous ring on the outside and a softer, gel-like core inside.

Bulge (Ukrainian reports often say "protrusion") — the disc extends beyond the edges of the vertebrae, but its outer ring is not torn.
Herniation — part of the core pushes out of the disc through a tear in the ring. In everyday speech this is often called a "slipped disc", although nothing actually slips. The report may name the type: "extrusion", or, if a fragment has broken away, "sequestration".
"Contact with the nerve root", "nerve root compression" — the disc is touching or pressing on a nerve root. Whether that explains pain or numbness in your leg is for a doctor to decide after examining you.

Radiologists do not all use these words in quite the same way — in English-language reports, for example, "protrusion" is usually counted as a type of herniation rather than a bulge. So comparing your report with someone else's tells you very little.

"Osteochondrosis" is a word you will often see in Ukrainian and Russian reports. It usually refers to age-related (degenerative) changes in the discs and the neighbouring parts of the vertebrae: the disc becomes lower and less springy, and small bony outgrowths appear at the edges of the vertebrae. English-language reports tend to describe the same thing as degenerative changes. It is a description of the tissues. Why it hurts now, and what to do about it, is for a doctor to work out alongside an examination.

An MRI finding and pain are not always the same thing

An MRI shows the structure of tissues, not pain. In 2015 a systematic review brought together 33 studies in which people with no back symptoms had MRI or CT scans — more than 3,000 people in all.

Signs of disc wear were found in more than a third of 20-year-olds and in almost all 80-year-olds; disc bulges in nearly a third of 20-year-olds and in most 80-year-olds. Disc protrusions — which international terminology counts as a type of herniation — were found in roughly 29–43% of people, depending on age. The authors concluded that many of these changes are part of normal ageing and have to be interpreted in the light of the person's condition.

In other words, a finding may be the cause of pain, or it may be a bystander that was there long before. Sometimes it genuinely explains the symptoms — for example, when a disc presses on a nerve root and the pain runs down the leg with numbness. Telling the two apart is a doctor's job, matching the images with an examination. And the wording of a report is no reason to protect your back from every movement: fear of moving often gets in the way more than the finding itself.

Which doctor to see first, and why an MRI "just in case" more often confuses things, is covered in our article back pain: who to see.

When to see a doctor straight away: red flags

Most episodes of back pain are not dangerous. But some signs call for a doctor rather than a physical therapist — and quickly.

Immediately — call emergency services on 103 or go to an emergency department. These signs can point to cauda equina syndrome (compression of the nerve roots at the lower end of the spinal canal) or to severe compression of a single nerve root. In either case, any delay is dangerous:

numbness around the genitals or back passage (anus), in the buttocks or inner thighs — the so-called "saddle area";
problems passing urine or opening your bowels: being unable to go, leaking, or a feeling that you have lost control;
sudden changes in sensation in the genitals or in sexual function, together with back pain;
pain, numbness or weakness in both legs at once;
weakness in a leg that is getting worse: the foot "drops", slaps on the floor or catches at the toes, or the leg gives way.

Without delay — to a doctor, and before any sessions:

pain that began after a fall, a blow or a road accident, especially if you are over 50 or have known osteoporosis; after a serious injury, call 103 straight away;
pain with a fever or chills;
cancer, now or in the past;
weight loss you cannot explain;
pain that wakes you at night, does not depend on your position and does not ease at rest;
pain that gets worse day by day despite rest;
long-term use of corticosteroids, or a weakened immune system.

This list is not a diagnosis but a filter. If you are unsure, call us: if we hear any of these signs, we will tell you plainly that you need a doctor first.

What a physical therapist does: assessment, graded movement, return to everyday loads

A physical therapist works not with "the herniation on the scan" but with the person: how you move, what is difficult for you right now, and what in your daily load keeps the pain going.

Assessment. First a conversation: when it started, where it hurts — in the lower back or down the leg, what makes it worse and what eases it, what your doctor has already said. Then an examination: how you bend, sit down, stand up and walk, how mobile your back and hips are, the strength and sensation in your legs. That last part is not for diagnosis; it is there so we do not miss signs that mean you need a doctor first.

Graded movement. We start with the positions and movements you can manage now and add load gradually, guided by how you respond: how the pain behaves during the session, that evening and the next morning. We keep a separate eye on the leg: if pain or numbness spreads further down it, we reduce the load, and if weakness is increasing, we tell you straight away that you need a doctor.

Return to everyday loads. The goal is not a "perfect spine" but your real life: getting through a working day, lifting a child or the shopping, getting back to sport. We practise the technique of those actions and gradually prepare the muscles for them.

Work at home is an essential part, but which exercises you do is decided after the assessment. How we approach back pain in general is described on the back, neck and joint pain page.

What we do not do: "putting the disc back" and spinal manipulation

We do not "put discs back", and we do not perform spinal manipulation. Here is why.

A disc is not a part that has "slipped out" and can be pushed back into place by hand. A herniation is a change in the tissue of the disc itself, and no amount of pressing or thrusting will "put it back".

Spinal manipulation — short thrust movements, often with the familiar cracking sound — is performed in Ukraine by a doctor of the relevant specialty. In Ukraine, physical therapists do not perform it. What we do with our hands is soft manual techniques: slow work with muscles, fascia and joint mobility within the physiological range, with no thrusts. They go alongside exercise, not instead of it. The UK's NICE guideline likewise advises considering manual therapy only as part of a package of care that includes exercise.

Nor do we promise that a herniation will shrink, "dissolve" or "go back into place", and we do not name a number of sessions in advance.

Bed rest, back braces and "forbidden" exercises: what the guidelines say

Three common pieces of advice after an MRI report are to lie down, wear a brace and avoid bending. Here is what clinical guidelines say about them.

Bed rest. The NICE guideline on low back pain and sciatica advises explaining the nature of the pain to the person and encouraging them to carry on with their normal activities. Lying down for a while when the pain is acute is fine. Staying in bed for long "so the disc does not move" is not: muscles weaken, and movement becomes even more frightening afterwards.

Braces. NICE advises against offering belts or corsets for low back pain, with or without sciatica. The 2023 WHO guideline places lumbar braces, belts and supports among the interventions that should not be used routinely. It is a different matter if your surgeon has prescribed a brace, for example after an operation: then the surgeon's instruction applies.

Traction. NICE advises against offering traction — mechanically stretching the spine — at all, and the WHO advises against its routine use.

"Forbidden" exercises. These guidelines contain no universal list of movements to avoid with a herniated disc. NICE advises taking the person's needs, preferences and capabilities into account when choosing the type of exercise. So "you must never bend", passed on by someone else, is not a rule. The rule is how your body responds and the restrictions set by your doctor — or, after surgery, by your surgeon.

One caveat: the WHO guideline covers long-lasting lower back pain without a specific identified cause, so it is a point of reference rather than a ready-made answer for every herniation.

Exercise therapy for a herniated disc: why there is no universal routine

Search for "exercises for a herniated disc" and you will find dozens of ready-made routines. We deliberately do not publish one.

The same word in a report, different people. One person's lower back aches after a long time sitting; another's pain runs down the leg when walking. A movement that helps one of them may make the other's symptoms worse.
What matters is the response, not the name of the exercise: how the pain and the sensations in the leg change during the load and after it. That shows up in a session, not in a text online.
The programme changes: what was the limit at the start later becomes the warm-up, and during a flare-up the programme is scaled back. A ready-made routine knows none of this — nor does it know your doctor's restrictions.

So exercise therapy for a herniated disc is not a set of exercises "for the herniation" but graded work: mobility, strength in the trunk and legs, stamina for walking and sitting, and technique in everyday movements. Among the options for long-lasting lower back pain, the WHO lists structured exercise programmes and education. How sessions are run is described on the physical therapy (exercise therapy) page.

Massage for a herniated disc: what it can and cannot do

Massage can ease the muscle tension that often comes with back pain, bring some relief and prepare the tissues for exercise.

Massage cannot "put a disc back", shrink a herniation or take pressure off a nerve root. Nor does it replace exercise: if your everyday load stays the same, the effect of a session is usually temporary.

The WHO includes massage among the options that can be offered to people with long-lasting lower back pain, although the evidence is still limited. NICE advises considering soft-tissue techniques such as massage only alongside exercise.

See a doctor first, not a massage therapist, if numbness or weakness in a leg is getting worse, if the pain began after an injury, or if any other red flag is present. After recent surgery, massage needs your doctor's clearance.

At our practice, massage is given by massage therapist Alona Kaliuzhna. For back pain this is usually therapeutic massage — focused work on a specific area; recovery massage is gentler and more general. They are separate courses, and the type is chosen after a conversation about your health. "Therapeutic" is the traditional name of this type of massage, not a promise of a cure. More on the massage at our practice page.

After disc surgery: when you can start sessions

The short answer: when your operating surgeon allows it, and within the limits they set.

Disc operations differ: removing the herniation (microdiscectomy, endoscopic surgery) or stabilising the vertebrae. The type of operation and how it went determine how long you can sit, whether you can bend and lift, and whether you need a brace. That is why there is no general answer to "how soon can I…".

We start once your surgeon has given permission and work within their restrictions, without bringing stages forward even if you feel well. If the permission is vague, check with your doctor first — we do not guess. If your restrictions change at a follow-up appointment, tell us and the programme will be rebuilt around them.

What we usually look at in the consultation:

your discharge summary, the operation notes if you have them, your surgeon's written instructions, and MRI reports from before and after the operation, if one was done;
how you get out of bed, sit down and walk, and whether you need support;
the strength and sensation in your legs;
what remains of the pain: in the back, in the leg, around the scar;
which everyday tasks are hardest right now.

Then comes a programme within what is allowed: getting up and sitting down, walking, strength in the trunk and legs.

Warning signs after surgery — do not wait for the next session:

numbness around the genitals or back passage, problems passing urine or opening your bowels — call 103 immediately;
new weakness in a leg, or weakness that is getting worse — contact your surgeon immediately, and if you cannot reach them, call 103;
fever, chills, redness or swelling around the wound, discharge from it, or the wound edges coming apart — contact your surgeon without delay;
clear fluid leaking from the wound, or a headache that worsens when you sit or stand and eases when you lie down — contact your surgeon the same day; if fever, a stiff neck or confusion appear as well, call 103 immediately;
leg pain that has come back as it was before the operation, or has suddenly become much worse — contact your surgeon;
pain, swelling, redness or warmth in the calf — see a doctor the same day, as this can be a blood clot; sudden shortness of breath or chest pain — call 103 immediately.

These signs are assessed by a doctor — not by the patient, and not by a physical therapist.

Questions and answers

Can I exercise if I have a herniated disc?

In most cases, yes: graded movement is part of working with back pain, and a herniation in a report is not in itself a reason to stop moving. But exercises are chosen after an examination, not from the name of the diagnosis. If any red flags are present, see a doctor first.

Do I need an MRI before the consultation?

No. Referrals for investigations come from a doctor, and NICE advises against routine imaging for low back pain outside specialist care. If you already have an MRI, bring both the images and the report. If the examination shows signs that call for investigations or a doctor, we will tell you plainly.

Can I have a massage if I have a disc bulge?

If it is muscle tension in the back with no red flags, usually yes; tell the massage therapist about the bulge before the session. If the pain runs down your leg or there is numbness, come for a consultation with the physical therapist or see a doctor first; if weakness in the leg is getting worse, see a doctor. After recent surgery, massage needs your operating surgeon's clearance.

Sources

NICE (National Institute for Health and Care Excellence, UK). Low back pain and sciatica in over 16s: assessment and management (NG59). Published 2016, last updated 2026.
World Health Organization. WHO guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings. Geneva, 2023.
Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology, 2015; 36(4): 811–816.

If you are in Zaporizhzhia

Rehab Place is an outpatient physical therapy practice with one-to-one sessions, run by Oleksandr Kaliuzhnyi, physical therapist, in practice since 2012. We work with disc herniations and bulges, including after disc surgery — with the operating surgeon's clearance.

A first consultation takes about 60 minutes — conversation, examination, testing and a plan of work — and costs UAH 300. Service members and veterans get 30% off the consultation and sessions: the consultation is UAH 210 instead of 300. The discount applies on presentation of a combat participant certificate (UBD).

Sessions are conducted in Ukrainian and Russian. You can write to us in English to arrange the details.

Bring your MRI report and images if you have them, any doctors' reports, and, after surgery, your discharge summary and your surgeon's instructions.

Address: 28 Pavlokichkaska St., Zavodskyi Palace of Culture building, Zavodskyi district — how to find us. The practice is on the ground floor, with a ramp at the building entrance and parking nearby. The toilet in the building is not adapted for visitors with reduced mobility — please take this into account when planning your visit.

Opening hours: Mon–Fri 09:00–19:00, Saturday by prior appointment, Sunday closed. To book or ask a question: +380 97 824 48 01.

This article does not replace a doctor's consultation. Questions of diagnosis, investigations, surgery, medication and safe levels of activity are decided by your doctor.

Disc herniation and bulge: what physical therapy can and cannot do